Provider Demographics
NPI:1497949044
Name:ADVANCED DENTAL GROUP LLC
Entity Type:Organization
Organization Name:ADVANCED DENTAL GROUP LLC
Other - Org Name:ADVANCED DENTAL CONCEPTS OF WINFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-663-6579
Mailing Address - Street 1:10780 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7615
Mailing Address - Country:US
Mailing Address - Phone:219-663-6579
Mailing Address - Fax:219-663-5085
Practice Address - Street 1:10780 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7615
Practice Address - Country:US
Practice Address - Phone:219-663-6579
Practice Address - Fax:219-663-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental